ABC AU PAIRS

AU PAIR APPLICATION FORM DATE _________________

PERSONAL DETAILS
First Name & Surname ___________________________________________
ID number ___________________________________________
Date of birth ___________________________________________
Age ___________________________________________
Contact Number/s ___________________________________________
Email Address ___________________________________________
Residential address ___________________________________________
___________________________________________
___________________________________________
Marital Status ___________________________________________
Dependents ___________________________________________
Drivers license (YES/NO) Code: ______________Date: __________________
Car Make and Model ___________________________________________

Father’s Name Contact Numbers

___________________ ____________________
Mother’s Name Contact Numbers
___________________ ____________________
How many siblings do you have and what are their ages?
______________________________________________________________________
How would you describe your family?
______________________________________________________________________
How would you describe your relationship with your family?
______________________________________________________________________
Have you ever been charged or convicted of a criminal offence? Give Details:
______________________________________________________________________
Have you ever taken narcotics / non prescription drugs? Give Details:
______________________________________________________________________
Do you suffer from emotional, personality or nervous problems? (Yes/No)
If yes, please describe
______________________________________________________________________
Can you swim? (Yes/No)

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Do you have a disability, if so what?
___________________________________________________________________
Do you have any allergies?_______________________________________________
Are you on any medication?______________________________________________
What are your long term goals? __________________________________________
______________________________________________________________________
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Personality
What best describes your personality and lifestyle: (Circle appropriates)
Positive Negative Outgoing Shy
Loud Calm Athletic Attentive
Organised Creative Loving Artistic
Social Witty Messy Nature Lover
Independent Honest Hardworking Responsible
Caring Dependable Lazy Sporty
Clever Average Fun Loving Exciting

Other: ______________________________________________________________

REQUIREMENTS & EXPECTATIONS

What times are you available to au pair?
Day From To
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

What date will you be available from? ____________________________________

Estimated Duration? ________________ ___________________________________
What areas would you like to work:_______________________________________
Would you prefer: Live-in Live-out
Would you prefer: Permanent Temporary
Would you prefer: Half-day Full-day
What is the maximum number of children you would be able to cope with?
______________________________________________________________________

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I have experience with children aged (circle all that apply)
0-12 months 1-2yrs 3-5yrs 6-8yrs 9-12yrs 12yrs+

Please provide duties:

__________________________________________________________________
__________________________________________________________________
I want to work with children aged (circle all that apply)
0-12 months 1-2yrs 3-5yrs 6-8yrs 9-12yrs 12yrs+

Do you have any preference as to sex and ethnicity of the children? Please state:
______________________________________________________________________
Why do you want to be an Au Pair?
______________________________________________________________________
Why do you like these ages? Please be specific:
______________________________________________________________________
Do you have any experience caring for mentally / physically handicapped children? If
yes, please provide the details:
______________________________________________________________________
Do you have experience working with children with ADD/ ADHD, learning or behavioural
problems? _____________________________________________________________
Which of the positions below would you like to apply for: (circle appropriate)
Au Pair work Tutoring Baby sitting Lifting

CHILDCARE REFERENCES
1. Family/Institute: __________________________________________________
Duration: __________________________
Contact Person: ____________________
Contact Number: ____________________
Job description (Please provide full details of ages of children and what your duties
were): __________________________________________________________
_________________________________________________________________
Salary: ____________________
Reason for leaving: _________________________________________________
__________________________________________________________________

2. Family/Institute: __________________________________________________
Duration: __________________________
Contact Person: ____________________
Contact Number: ____________________

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 Job description (Please provide full details of ages of children and what your duties
were): __________________________________________________________
_________________________________________________________________
Salary: ____________________
Reason for leaving: _________________________________________________
__________________________________________________________________
Duration: __________________________
Contact Number: ____________________
Responsibility: ____________________________________________________

3. Family/Institute: __________________________________________________
Duration: __________________________
Contact Person: ____________________
Contact Number: ____________________
Job description (Please provide full details of ages of children and what your duties
were): __________________________________________________________
_________________________________________________________________
Salary: ____________________
Reason for leaving: _________________________________________________
__________________________________________________________________
Duration: __________________________
Contact Number: ____________________
Responsibility: ____________________________________________________

DRIVING ABILITY
Do you have a valid drivers licence? __________________________
Do you have any endorsements on your licence? __________________________
Have you ever had an accident? __________________________
How often do you drive? __________________________
What car do you drive? __________________________
Is your motor vehicle roadworthy? __________________________
Is your motor vehicle insured? __________________________

SMOKING
Do you smoke cigarettes? If yes, how many a day?
______________________________________________________________________

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NON SMOKING DECLARATION:
The vast majority of families have strong views on smoking. If you do smoke, but agree
not to in the home of your host family, or when responsible for their children, then tick
YES below. You will be expected to abide by your decision, so consider it carefully.
YES NO

EDUCATION
Highest Grade passed & Year Completed?
______________________________________________________________________
When did you matriculate and at which school?
______________________________________________________________________
Subjects Completed and Symbols Obtained:
1. ____________________ 2. ____________________
3. ____________________ 4. ____________________
5. ____________________ 6. ____________________
7. ____________________ 8. ____________________

Are you currently studying, if so please name course/qualification and year:

______________________________________________________________________

Please list all diploma’s & degrees as well as year completed:

______________________________________________________________________
What Au Pair Related Qualifications do you have?
______________________________________________________________________

INTERESTS AND HOBBIES

Please circle the areas that best describe your interests and hobbies:
Swimming Horse Riding Cycling Snow Skiing
Water Skiing Snow Boarding Tennis Running
Gymnastics Writing Reading Arts and Crafts
Musical Instruments Piano Guitar Violin
Flute Choir Dance Photography
Artwork Computers Community Service

How do you spend your spare time?

________________________________________________________________
Do you have any other talents or special skills which may be useful when caring for
children e.g. First Aid?
_________________________________________________________________

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AU PAIR DUTIES
Would you be prepared to do the following? Yes No
Get children up and ready in the mornings:
Prepare breakfast:
Pack lunches:
Take children to school:
Fetch children from school:
Prepare lunch and/ or snacks:
Take children to extramural activities:
Supervise/ assist with homework/ projects:
Take children on outings:
Prepare dinner for children:
Bath children:
Run errands for family:
Grocery shopping:
Travel with family:

AU PAIR REMUNERATION
Remuneration depends on your experience as well as hours worked per week. As your
agency, ABC Au Pairs will negotiate the best rate with the family, either as an hourly
rate or a fixed monthly rate. The family will pay this directly to you. As an Au Pair you
can expect a rate between R35 and R80 per hour depending on your experience and
qualifications. These rates do not include travel. Travel could be reimbursed according to
AA rates. Usually the family would decide to include or exclude a travel allowance. If an
employee should have a temporary placement, he/she will be required to include times
travelled on their time sheets to be reimbursed.

Where did you hear about ABC Au Pairs? _______________________________

AU PAIR LETTER
On the accompanying page, write a letter to your prospective family(You may type one
up if you prefer). Include the following:
 Why you want to be an Au Pair
 Any relevant Childcare experience
 Interests, hobbies and goals for your future
 About your family
 Your personality and characteristics
 What is your definition of a good Au Pair

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ADDITIONAL DOCUMENTATION
Kindly ensure that you bring the following along to your interview with ABC Au Pairs:

 A copy of your CV
 Copies of your childcare related references (if applicable)
 Copy of your ID and driver’s license (Required for every position!)
 Copies of any childcare, first aid, degree or diploma certificates (if applicable)
 A passport size photo/Email a photo to us
 Two child care recommendation letters – references must contain contact names
and telephone numbers (if applicable)
 The signed application form
 Indemnity Form – this is a form giving ABC Au Pairs permission to do Criminal
Record, Drivers license and ID Validation checks

DECLARATION

I, _______________________________________________declare that the

information supplied is true and correct.

I understand that it is my responsibility to inform ABC Au Pairs of any employment, both

temporary and permanent, offered to me by persons (and their agents) to whom I have
been introduced by the agency.

ABC Au Pairs will not accept any liability for your conduct prior, during or after the
period of employment with the host family. As soon as you are employed by a host
family, the relationship is between the host family and yourself and ABC Au Pairs is
excluded there from.

Signature of applicant ________________________________

Date and place signed _________________, ____________________

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 Agreement between ABC Au Pairs and Prospective Au Pair

MEMORANDUM OF AGREEMENT
entered into between:
ABC Au Pairs
(hereinafter called “the agency”)
And

_____________________________________________

The prospective au pair which will care for and look after a chosen Family’s respective
children (hereinafter called “the au pair”)

Definitions:
“the parties” shall mean the agency and the au pair, collectively;

“the Family” shall mean a family chosen by the agency which will require the services of
a prospective au pair, and once the au pair is placed at such family, the family will
employ the au pair, should the au pair be an acceptable candidate for the family.

- All words, terms and phrases used in this agreement importing any one gender shall
be deemed to include both the other two genders. All references in this agreement in the
singular shall include the plural, and vice versa.

- In the event of any clause in this agreement or any part of any such clause being
found to be invalid for any reason whatsoever, such clause or part thereof, shall be
severable from the remainder of this agreement and shall not affect the validity of the
remainder of this agreement.

Recordal:
It is hereby recorded that the agency wishes to enter into an agreement with the au
pair, in that the agency will act as an agent to the au pair and will endeavor to find the
au pair a suitable Family, which will employ the au pair and where the au pair will be
placed at, and to which family the au pair will tender her services and duties to. The au
pair’s duties will include (but are not limited to) caring for the Family’s children and
looking after the needs of such children.

The above parties hereby agree to the terms and conditions as set out hereunder, in this
agreement:
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• The au pair will carry out her childcare responsibilities for the benefit of the respective
Family, which chooses to make use of her services, to the best of her ability. She will be
punctual and be dedicated.
• She agrees to abide by the regulations and rules as set by the respective Family.
• She agrees that if she is found to be in the possession and/or under the influence of
any unlawful narcotics or under the influence and/or abuse of any alcohol whatsoever,
during the course of rendering her services and or performing her responsibilities, she
will be subjected to a summary dismissal,- with immediate effect- and criminal charges
may be brought against the au pair.
• As listed in the preceding application form, attached hereto, the au pair certifies and
agrees that all the information set out therein, is true, correct and accurate, and
furthermore the au pair hereby states that she has never in the past been convicted of
any criminal offence, whatsoever.
• The au pair, furthermore, indemnifies the agency and its respective staff against, any
loss, harm or damages that that she may suffer as a result of her tendering her
services, within or with regards to the respective Family, and/or to the respective au
pair program. In terms of this clause e), the agency cannot now nor ever be held liable
by the au pair.
• The au pair agrees to congenially participate in the respective Family’s activities, the
cultural traditions, meals and social events of the family, and she will carry out her
duties and responsibilities to the best of her abilities.
• The au pair will not allow any of her friends or relatives, at any time, into the Family’s
home, without prior arrangement and/or agreement, being reached, to do so, between
the family and the au pair.
• While caring for the children the au pair agrees to behave n a good and proper
manner, and to conduct herself in a manner that is acceptable to the Family, and in so
doing taking into account the Family’s respective values and morals.
• The au pair will NEVER physically and or psychologically, hurt, abuse or harm the
Family’s children in any way whatsoever.
Should this occur, there will be immediate criminal charges brought against the au pair,
together with any corresponding action for damages.
• The au pair will not smoke in the Family’s home; nor will she smoke near to and/or in
the presence of the Family’s children.
• The au pair undertakes to NEVER pick up and/or provide transport to, any hitchhikers,
while driving the Family’s children from one destination to another.
• The au pair understands that the agency has the sole discretion upon whether to
accept her application or to reject it.
• The au pair agrees that the agency and its respective staff will act on her behalf, in
appointing her and/or placing her, and that none of them (the agency and its respective
staff) will be nor can be held liable (in any manner whatsoever) by the au pair in respect
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of any loss, personal injury, damages, delays or expenses which may be suffered and/or
incurred by the au pair as a result of any act or omission made by any member of the
respective Family. Furthermore, the agency will not be held liable in any manner
whatsoever, should the au pair suffer any loss, harm, personal injury or damages, in
providing her services and duties for/to the benefit of the Family; and the same will be
applicable if the au pair uses any other facility or service, arranged on the au pair’s
behalf, by the family and/or the agency.
• The au pair agrees to reimburse the Family for any harm, loss or damages caused to
their household, property, motor vehicle and/or the Family’s assets, as a result of the au
pair’s negligent and/or intentional actions. The au pair will be liable for the
aforementioned damages and/or losses, should they occur, and furthermore she will be
liable for any personal telephone calls made from the family’s respective premises.
• Should the family not pay the placement fees due to ABC Au Pairs for the placement of
the au pair, the au pair agrees to leave the respective family effective immediately and
allow ABC Au Pairs to find them alternate employment. However should the Au Pair wish
to continue in the employ of the family guilty of not paying the placement fees the Au
Pair will be required to pay an equal amount to that of the original placement fees to
ABC Au Pairs.

Applicant Signature: _________________________

Date: _________________________

ABC Au Pairs Agent Signature: _________________________

Date: _________________________

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AU PAIR MOTIVATION LETTER

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